Background to this inspection
Updated
20 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Turning Point-Follybridge House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Follybridge accommodated five adults with learning disabilities at the time of our inspection. The service provided personal care up to six people who have a learning difficulty. At the time of our inspection five people lived at the service. Staff were present to care for people 24 hours a day and included a sleeping night staff and one who was awake all night.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We looked at previous inspection reports
.
During the inspection-
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We examined three people’s care plans and spoke with three staff including the acting manager, a senior manager and a regional manager. We reviewed two people’s medicine records and examined records related to the running of the service including incident and accident reports, audits and recruitment documents.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at accident reporting including medical notes and legionella and maintenance records. We corresponded with four professionals from the local authority.
Updated
20 August 2019
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 18,19 and 20 February 2019. Breaches of legal requirements were found. We issued two warning notices, which instructed the provider what areas and by when we expected improvement to made to the service.
We undertook this focused inspection to check they had made the necessary improvements and to confirm they now met legal requirements. The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection,by selecting the ‘all reports’ link for Turning Point-Follybridge House on our website at www.cqc.org.uk.
Enforcement
During this inspection we have identified a breach to Regulation 18: (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 during this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service and what we found
At the last inspection in February 2019 we found areas of concern relating to the safety and management of the service. We issued two warning notices. During this inspection we found improvements had been made to meet the requirements of the warning notices. However, some areas required further improvements. We found a breach of Regulation 18: (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009 at this inspection. This was because the provider failed to inform the Commission of an accident a person experienced. The Commission is unable to monitor how care is provided in services if we do not receive notifications.
During this inspection we also made two recommendations this was because we found although improvements had been made to the cleanliness of the service this could be enhanced further. The second recommendation was in relation to the speed and efficiency of responses when there were problems with equipment or the environment. For example, although Legionella tests had been completed in March 2019 the results weren’t provided until July 2019. The provider failed to check on the results, which placed people at risk.
The service didn’t apply the full range of principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, due to the service’s location there were limited opportunities for independence and community inclusion.
The service was situated on a busy main road, there was no pavement and no local amenities. This resulted in people not being supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
The service has a registered manager in place, who was not present during the inspection. An acting manager was covering in their absence. They had brought about improvements throughout the service with the support of the provider.
We found the environment had been decorated throughout, minus the laundry room, the spare bedroom and the office. The service felt homelier and more attractive than at the previous inspection.
Staff recruitment practices had improved which meant people were protected from the risk of being cared for by inappropriate personnel.
People’s care plans had improved, and guidance was available to staff about how to care for people with diabetes. We discussed how these could be developed by including a description of hypoglycaemia (low blood sugar levels) and what action staff should take.
Medicines were managed and stored safely. Quality assurance audits had been completed and action plans recorded who was responsible and when the completion date was for any improvements.
Staff had received training in duty of candour this would enable them to comply with the regulation and to uphold an open and honest relationship with those they cared for.
The service worked in partnership with professionals and organisations to enhance the care they provided to people. For example, the local clinical commissioning group (CCG) supported the service and provided training and advice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement report published (published 22 May 2019).
Following the previous inspection, we took enforcement action and issued two warning notices to the provider in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection we found some improvements had been made and the provider had met the requirements of the warning notices but was in breach of a Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.